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As a society, we typically reserve the term grief for those who have lost a loved one. However, you may be surprised to know that you may be experiencing varying stages of grief at this time. The loss of a normal world or normal life suddenly disappearing has created numerous challenges. It may be uncomfortable to accept that we are grieving, however, David Kessler, an expert on grief, explained that “change is actually grief and grief is usually a change we didn’t want.”1

Five Six Stages of Grief

The classic five stages of grief by Elisabeth Kübler-Ross include denial, anger, bargaining, depression and acceptance.2 David Kessler recently created a sixth stage of grief after experiencing significant loss - meaning.1 These stages are tools that help identify what we may be feeling, but they are not completed in a linear timeline. Not everyone shares the same experience or progress in the same order.

Denial. Denial is the first stage of grief. It is a common defense mechanism to give one time to process the loss. Denial and shock help us to cope and make survival possible. It is your body’s way of letting you only deal with what you can handle. As you accept the reality of the situation, you become stronger and the denial begins to fade.2

Anger. According to David Kessler, anger is a necessary step of the healing process. Allow yourself to feel your anger, even if it may seem endless. The more you are willing to feel anger, the more it begins to dissipate allowing for more healing. Your anger may extend to friends, your family, yourself and even to God. Underneath anger is pain. Pain of feeling deserted and abandoned. If someone lashes out towards you, keep in mind that they may be going through this stage of grief.2

Bargaining. During intense emotions of vulnerability and helplessness, it is common to try to find ways to regain control. In the bargaining stage of grief, you may find yourself creating a lot of “what if” and “if only” statements. We want life returned to what it was.2

Depression. After bargaining, our attention moves squarely into the present. You may be able to embrace and work through your emotions or you may choose to isolate yourself from others in order to fully cope with loss. Depression may feel overwhelming. You may feel foggy, heavy, and confused. It may feel as though it will last forever. This type of depression is not a sign of mental illness. It is the appropriate response to a great loss. If grief is a process of healing, then depression is one of the many necessary steps along the way.2

It is important to state that the clinical depression is different from complicated grief. Symptoms of complicated grief include:

a powerful pain when you think of your lost loved one

heightened focus on reminders of your lost loved one

an overall feeling of numbness

a feeling of bitterness when you think about your loss

a loss of purpose or motivation

a loss of trust in friends, family, and acquaintances

an inability to enjoy life.3

Symptoms of clinical depression can be similar, however clinical depression can cause other unique symptoms, such as:

Constant sadness, anxiety, or feelings of emptiness

feelings of guilt or helplessness

loss of interest in hobbies

insomnia or oversleeping

physical aches that don’t go away with treatment

suicidal thoughts or suicide attempts.3

You can have symptoms of both grief and clinical depression at the same time. However, grief and clinical depression must be treated differently. Contact your primary care provider (PCP) if you believe you may be experiencing clinical depression. People with preexisting mental health conditions should continue their treatment and be aware of new or worsening symptoms. If you think someone is at immediate risk of self-harm or hurting another person, call 911. If you think someone is considering suicide, get help from a crisis or suicide prevention hotline such as the National Suicide Prevention Lifeline at 1-800-273-8255.

Acceptance. Acceptance does not mean that one is “all right” or “OK” with what has happened. It doesn’t mean you have moved past the grief or loss. It does however mean that this new reality is the permanent reality. We will never like this reality, but eventually we accept it. Finding acceptance may be just having more good days than bad ones. Instead of denying our feelings, we listen to our needs; we move, we change, we grow, we evolve.2

Meaning. David Kessler noted from his personal experience of grieving that finding meaning beyond the stages of grief can transform grief into a more peaceful and hopeful experience. Finding ways to honor the memory of a lost loved one or achieving a personal goal during this pandemic can bring healing.2

What You Can Do

Sadly, many people are losing their lives due to this pandemic. Your life may be touched by such a loss. The grief process is never easy to handle, but is very important in the maintenance of mental health. Should you lose a loved one, allow yourself to grieve. Here are just a few suggestions:

Give yourself the opportunity to talk to others about your loved one and your sadness.

Take time out of each day to feel your sadness. Cry, sit with your memories of the things you will miss.

Do something to honor your loved one.

Draw a picture.

Write a letter.

Write a poem.

Write a eulogy.

Sing a song.

Make a setlist and record it.

The Takeaway

The key to understanding grief is realizing that no one experiences the same thing. What we are experiencing is loss and are feeling the sadness. If we name it, we are allowing ourselves to feel the sadness.4 Suppressing the emotions is not healthy or healing. If grief is left unrecognized and shoved away, it can negatively affect “every aspect of our being – physically, cognitively, emotionally, spiritually.”5 Grief is very personal and does not come with a time limit. Life has changed dramatically in the last few weeks, of course this brings up many feelings including grief. Let yourself feel it, and then keep going.

By: Sudin Thomas, MSN, FNP-BC

References

1Grief.com. (2020). COVID-19. https://grief.com/covid-19/

2Grief.com. (2020). The five stages of grief. https://grief.com/the-five-stages-of-grief/

2020 has turned out to be much different than most (if not all) would have expected. As more information about Coronavirus unfolds, a wide range of thoughts, feelings, and reactions may appear. Below are some information and resources that we hope will be helpful.

Common Reactions

Everyone reacts differently to stressful situations. How you respond to the outbreak can depend on your background, the things that make you different form other people, and the community you live in.

· Fear and worry about your own health and the health of your loved ones

· Stress about leaving the house for essential reasons

· Changes in sleep or eating patterns

· Difficulty sleeping or concentrating

· Worsening of chronic health problems

· Increased use of alcohol, tobacco, or other drug1

Ways to Support Yourself

Taking care of yourself, your friends, and your family can help you cope with stress.

· Stay informed with accurate information from a reputable source by checking the dedicated CDC website.

· Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting.1

· Stay healthy. Adopt healthy hygienic habits such as washing your hands with soap and water or an alcohol-based hand sanitizer, frequently, and certainly after sneezing or before/after touching your face or a sick person.2Remember that social distancing is not just for those who have an underlying medical condition or seniors.

· Practice mindful thankfulness. Daily journaling has been shown to improve your mental well-being.3 The Mayo Clinic Health System has created a four-week virtual program to discover gratitude that begins on March 30 to May 1st. Click here for the link.

· Connect with others. Talk with people you trust about your concerns and how you are feeling.1

· Call your healthcare provider if stress gets in the way of your daily activities for several days in a row.

· People with preexisting mental health conditions should continue with their treatment and be aware of new or worsening symptoms.

· Be mindful of your assumptions about others. Someone with a cough or a fever does not necessarily have coronavirus. Self-awareness is important in not stigmatizing others in our community.2

· Keep your expectations low and be kind to yourself. Not every day will be a good day. For example, if it is raining, dark and gloomy outside, your mood may be affected. If you find that you’re feeling down multiple days in a row regardless of the weather outside, then refer to your healthcare provider.

Flu season is upon us again. According to the CDC and the Maryland Department of Health and Hygiene, there is widespread flu around the country and the state. Influenza is a respiratory illness with sudden symptoms that can include high fever, body aches, headache and cough.

We expect that this will be a busy flu season. This news is no cause for alarm, but it does give us the opportunity to practice effective prevention techniques for this type of illness.

Be a healthy Mustang and get a flu shot; it is not too late! Giant Pharmacy will be in the Wellness Center on Friday, January 31 from 11am-3pm to administer flu shots! Stop on in and get protected!

The Center for Disease Control and Prevention (CDC) is also closely monitoring the outbreak of a new coronavirus in China. These viruses usually cause mild to moderate upper respiratory tract illness like the common cold and are different than the influenza virus. The Wellness Center continues to monitor the CDC as well as the Maryland Department of Health and Mental Hygiene regarding the spread of this new virus. Please follow the link for information about coronaviruses:https://www.cdc.gov/coronavirus/index.html

To keep yourself healthy this semester you should:

Wash your hands frequently and use the hand sanitizing stations that are located around campus.

Cough into your sleeve or a tissue, not directly into your hands, and wash your hands immediately.

Avoid touching your face when you are ill and when healthy; this spreads germs!

Avoid sharing food, utensils, cups and water bottles.

The treatment for influenza for otherwise healthy people is “supportive” – meaning that our recommendations will often be that you rest, drink plenty of fluids and take fever-reducing medicine if you are diagnosed with the flu. Anti-viral medications (Tamiflu® and Relenza®) are generally not recommended for healthy people with the flu. In addition, most people who are infected with these illnesses will not require medical care. This means:

If you are sick, stay home and in bed. Avoid crowded places like the dining hall, classrooms, and restaurants to prevent spreading your illness to others. You should continue to do this until you have not had a fever for 24 hours.

If your home is within reasonable driving distance, we recommend that you go home to recover.

Recruit a friend (your “Flu Buddy”) to help care for you and bring you food when you are sick.

Take fever reducers like acetaminophen (Tylenol), ibuprofen (Advil) or naproxen (Aleve) if you have a fever. If your fever persists for more than three days in spite of fever reducers, please seek medical care.

Drink plenty of fluids. Avoid Emergency Rooms and Urgent Care Centers unless you are truly sick, as these locations will be crowded with many sick people with influenza. This may put you at risk of getting the flu.

Contact the Wellness Center at 443-352-4200 if you need medical advice or are unsure of what to do after reading this message.

For students who have chronic medical problems (ex. asthma, diabetes, obesity), it is important to visit the Wellness Center within 48 hours of developing flu-like symptoms.

The recent vaping-related lung injury and deaths are alarming and the providers at the Wellness Center felt that it was necessary to address this topic. You may not be surprised to know that there are many students on campus who use electronic cigarettes (e-cigarettes) or vape. Granted, the vape store planted directly across campus does not help. This blog will give you a quick background on e-cigarettes and vaping products, why these devices are unhealthy, and give you an update on the outbreak of lung injury/deaths.

Vaping is the popular shorthand for using e-cigarettes to “vaporize” nicotine.1 These devices were marketed as a “safer” way to inhale nicotine as it removed the risks associated with burning tobacco or cigarettes. These devices rapidly evolved into products with hundreds of flavor combinations and chemical compounds, including THC, the psychoactive ingredient in marijuana, and other marijuana extracts.1 The components of the liquid substance in e-cigarettes vary among brands. Many of these chemicals can cause toxic effects on the body, not due to the nicotine, but rather from the number and concentration of chemicals used to flavor the liquid.2,3 The base liquid of e-cigarettes is a blend of water, vegetable glycerine, and propylene glycol.2 When propylene glycol and glycerol (commercial name for glycerine) is heated in e-cigarettes, it creates compounds that release formaldehyde.2,4 Formaldehyde is a Group 1 carcinogen which means that it has the potential to cause cancer.2

"This risk for cancer is 5 to 15 times as high as the risk associated with long-term smoking."4

When inhaled, most of the formaldehyde quickly breaks down in the cells lining your respiratory tract and is breathed out.5 Even with low concentrations of formaldehyde, rapid onset of nose and throat irritation, cough, chest pain, shortness of breath, and wheezing can occur.5 “Higher exposures can cause significant inflammation of the lower respiratory tract, resulting in swelling of the throat, inflammation of the windpipe and bronchi, narrowing of the bronchi, inflammation of the lungs and accumulation of fluid in the lungs.”5 Also, high levels of formaldehyde will cause it to enter your blood. Once in your body, formaldehyde is rapidly broken down into other chemicals, most of which leave your body in the urine.5 A recent study with adolescents showed that although vaping may be less hazardous than tobacco smoke, those who used e-cigarettes had higher quantities of toxic chemicals in their urine compared to the control group (non-tobacco users).6

As of October 29, 2019, there have been 1,888 confirmed cases of lung injury associated with the use of e-cigarettes or vaping products, a rise from 1,604 cases reported the week prior.7 37 deaths have been confirmed with their age ranging from 17 to 75 years old.7 THC is present in most of the samples tested by the Food Drug Administration (FDA).7 At this time, the FDA and Centers of Disease Control and Prevention (CDC) have not identified the cause(s) of the lung injury with the only commonality among all cases being the use of e-cigarette or vaping products.7 The products containing THC, particularly those purchased from the street or informal sources such as friends, family members, illicit deals, are linked to most of the lung injury cases.7 Due this data and the continued ambiguity of the cause of lung injury, the CDC recommends that you DO NOT use e-cigarettes, vape, or use products that contain THC.

Also, for those who may not have heard, beginning October 1, 2019, the legal age to buy ANY tobacco product including e-cigarettes is now 21 in Maryland unless you are active duty military personnel.

If you are interested in information on vaping or smoking cessation, please contact the Wellness Center at (443)352-4200. You can also call the Maryland Tobacco Quitline, 1-800-QUIT-NOW, a FREE evidence-based counseling program available 24/7. Visit www.smokingstopshere.com for more information.

“Self-care” is a term that is frequently found on product ads on social media or casually mentioned when giving advice to a stressed out college student. It is easy to say the phrase, but let’s be real, does anyone have time to balance studying, work, social activities, relationships, to actually spend time on themselves? Many may say no, but reality is that you should.

Have you ever been around a toddler who missed their nap time or has been overstimulated? Trust me, you don’t want to be around them. They are usually cranky, whiny, or crying excessively. If it is crucial for toddlers to nap or have downtime, it should be just as important for adults who lead an extremely busy lifestyle to find ways to do the same. As a nurse practitioner, I have had several students come in displaying physical symptoms of stress and once all other diagnoses are ruled out, I refer them to meet with our counselors. Yes, you read that correctly. Your body can exhibit physical symptoms of stress if you do not spend time to unwind or practice “self-care.”

Physical symptoms of stress include:

Headaches, muscle tension, neck or back pain

Upset stomach

Dry mouth

Chest pains, rapid heartbeat

Difficulty falling or staying asleep

Fatigue

Loss of appetite or overeating “comfort foods”

Increased frequency of colds

Lack of concentration or focus

Memory problems or forgetfulness

Jitters

Irritability

Short temper

Anxiety1

A study in 2015 conducted across 108 U.S. college campuses found that three out of every four college student reported at least one stressful life event within the past year (ranging from personal appearance or social relationships to problems with family).2 Twenty percent said they experienced greater than five stressful life events within that same time frame. When asked about suicidal thoughts or attempts to harm themselves, one in five college students said they had thought of suicide, while one in ten actually attempted it. For students who identified as a sexual minority such as gay, lesbian, and bisexual had two to three times more suicidal thoughts or suicidal attempts than heterosexual students. Transgender students were among the highest in reported mental health diagnoses and suicidality.2 At Stevenson University, Dr. Linda Reymann, the director of the Wellness Center, has noticed a trend in students who lack self-care or coping strategies. “Lack of self-care can impact friendships. If a student has difficulty caring for themselves, it is challenging to put energy into a friendship. It goes back to the basic analogy, if your tank is empty, it is hard to give of yourself to others. Anxiety and depression are our top two diagnoses and I do believe a lack of self-care can impact the severity of symptoms.” Stress as a college student is very real and it is important to find ways to manage it.

So what exactly is “self-care?” Dr. Sally Bonefas, a clinical psychologist at the Wellness Center, defines it as “any conscious action we take in order to maintain or improve our mental, emotional, and physical wellbeing. Although the concept of self-care is logical, it is often overlooked in the busy-ness of life. Effective self-care reduces anxiety, raises mood, and improves the relationship with oneself and others. Self-care refuels our energy. It is not a selfish act, as it serves us as well as those around us.”

Here are seven ways to exercise self-care.

Good sleep quality is an essential human function – it allows our brains to recharge and our bodies to rest.3 Slight sleep deprivation or poor sleep is so crucial that it can affect memory, judgement, and mood.2 The Center of Disease Control (CDC) recommends 8 to 10 hours of sleep for teenagers up to 18 years of age. 4 For 18 to 60 year olds, the CDC recommends 7 or more hours per night. 3 Napping throughout the day can also improve energy levels.

Exercise burns extra calories, but it also releases endorphins and increases serotonin function in the brain.5 Low serotonin levels can lead to depression, obsessive-compulsive disorder, anxiety, panic, and even excess anger6. Exercise has an antidepressant and anxiolytic effect.5 The most consistent effect occurs when regular exercisers perform aerobic exercise (running, jogging, swimming, dancing, spinning, etc) at a level with which they are familiar. 5 Exercising for 30 minutes or more a day three to five days a week can significantly improve depression or anxiety symptoms. 7 Smaller amounts of physical activity (as little as 10 to 15 minutes at a time) may still make a difference. 7

Be kind to yourself. Are you overcritical of yourself? Do you replay mistakes in your head or punish yourself for your failures? Self-compassion is a powerful predictor of mental health. 9 For example, self-compassion reduces the risk of depression, anxiety, neurotic perfectionism while increasing life satisfaction and social connectedness. 9 Self-compassion represents acceptance towards all aspects of oneself including those that are disliked. When practicing self-compassion, you have the ability to face painful thoughts and feelings, without the drama or self-pity.9

Eating well. Self-care means making sure you are well fed. Are you eating food that provides you with quality energy to function?10 Do you make time to eat healthy meals or do you skip meals because you are rushing to class, work, or cramming for a test? I have had several students tell me they eat 1-2 meals a day and snack the remainder of the day due to time constraints. Some students even forget to eat because they are so focused on class work. Eating a balanced breakfast regularly and omega-3 based food such as fish (salmon, sardines, anchovies, etc), chia seeds, walnuts, and soybeans have shown to boost your mood.11

Journaling, meditation, and yoga. Journaling helps you process your feelings, ignite creativity centers in the brain and will help you be in the present moment.12 Writing your thoughts, feelings, and experiences allows for healing from stress and trauma.13 It can even boost your immune system.13 Meditation can alter your feelings of stress and anxiety.14 Meditation trains the brain to achieve sustained focus and to return to that focus when negative thinking, emotions, and physical sensations intrude.14 Meditation has also been found to change parts of the brain that becomes hyperactive in people with depression. It also helps protect the hippocampus (the area involved in memory). A study showed that people who meditated for 30 minutes a day for eight weeks increased the volume of gray matter in their hippocampus.14 Yoga encourages one to relax, slow their breathing and focus on the present, causing a shift from the flight-or-fight response to the relaxation response in the nervous system.15 Yogic practices inhibit the areas of the brain responsible for fear, aggressiveness and rage, and stimulate the rewarding pleasure centers creating a sense of well-being, feelings of relaxation, improved self-confidence and efficiency, lowered irritability, and an optimistic outlook on life.15 Consistent yoga practice can improve depression and lead to significant increases in serotonin levels.15Click Here for a list of recommended apps you can download to start your journey to relaxation.

Unplug from technology. Technology is designed to keep us constantly plugged in, yet never fully satisfied. We are left drained by the constant barrage of notifications preventing us from truly living.15 Personally speaking, I know it is not easy, but taking a step back is the best way to open up the creative space that is necessary as a college student. Research has shown that downtime replenishes the brain’s stores of attention and motivation, encourages productivity and creativity, and is essential to achieve our highest levels of performance.12

Seeing a counselor at the Wellness Center. If options 1-6 did not help improve your mood, consider seeing a counselor. Sometimes, it can be difficult to share a troubling personal experience with family and friends. You may not realize how traumatic events in your childhood can still impact you as you enter adulthood. Sometimes, you just need to talk to someone nonbiased about your life. You can call (443)352-4200 to make an appointment with our counselor or ask us for recommendations to local therapists.

Be Kind to Your Mind, a mental health and self-care retreat for students will be held on Sunday, November 10th from 1-4pm in the Claire Moore Room. To sign up contact Jenna Womack at jwomack2@stevenson.edu

By: Sudin Thomas, MSN, FNP-BC

References

2Liu, C. (2018). The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use. Depression and Anxiety, 36(1), 8-17.